0001493152-19-003944.txt : 20190326
0001493152-19-003944.hdr.sgml : 20190326
20190326162139
ACCESSION NUMBER: 0001493152-19-003944
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190325
FILED AS OF DATE: 20190326
DATE AS OF CHANGE: 20190326
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Chan Heng Fai Ambrose
CENTRAL INDEX KEY: 0001261725
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-32146
FILM NUMBER: 19705561
MAIL ADDRESS:
STREET 1: 2601 INSLAND PLACE TOWER
STREET 2: 510 KINGS RD N POINT
CITY: HONG KONG
STATE: K3
ZIP: 999999999
FORMER NAME:
FORMER CONFORMED NAME: CHAN FAI
DATE OF NAME CHANGE: 20030828
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: DOCUMENT SECURITY SYSTEMS INC
CENTRAL INDEX KEY: 0000771999
STANDARD INDUSTRIAL CLASSIFICATION: PAPERBOARD CONTAINERS & BOXES [2650]
IRS NUMBER: 161229730
STATE OF INCORPORATION: NY
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 200 CANAL VIEW BOULEVARD
STREET 2: SUITE 300
CITY: ROCHESTER
STATE: NY
ZIP: 14623
BUSINESS PHONE: 585 232 1500
MAIL ADDRESS:
STREET 1: 200 CANAL VIEW BOULEVARD
STREET 2: SUITE 300
CITY: ROCHESTER
STATE: NY
ZIP: 14623
FORMER COMPANY:
FORMER CONFORMED NAME: NEW SKY COMMUNICATIONS INC
DATE OF NAME CHANGE: 19920703
FORMER COMPANY:
FORMER CONFORMED NAME: THOROUGHBREDS USA INC
DATE OF NAME CHANGE: 19861118
4
1
ownership.xml
X0306
4
2019-03-25
0
0000771999
DOCUMENT SECURITY SYSTEMS INC
DSS
0001261725
Chan Heng Fai Ambrose
C/O DOCUMENT SECURITY SYSTEMS, INC.
200 CANAL VIEW BLVD., SUITE 300
ROCHESTER
NY
14623
1
0
0
0
Common Stock
1786531
I
See Footnote
Common Stock
500000
I
See Footnote
Common Stock
683000
I
See Footnote
Common Stock
2912
D
Common Stock
2019-03-25
4
C
0
446428
1.12
A
446428
I
See Footnote
Convertible Promissory Note
1.12
2019-03-25
4
C
0
446428
D
2019-02-18
2020-02-18
Common
446428
0
I
See Footnote
Held by Heng Fai Holdings Limited of which Reporting Person is the owner. The Reporting Person has dispositive control over these securities.
Held by BMI Capital Partners International Limited of which the Reporting Person is an owner and director. The Reporting Person has dispositive control over these securities.
Held by Hengfai Business Development Pte Ltd of which Reporting Person is the Chief Executive Officer and Owner. The Reporting Person has dispositive control over these securities.
On March 25, 2019, a Convertible Promissory Note in the amount of $500,000 was converted into 446,428 shares of the common stock of Document Security Systems, Inc. These shares are held by LiquidValue Development Pte Ltd, of which the Reporting Person is the owner and a director. The Reporting Person has dispositive control over these shares.
/s/ Heng Fai Ambrose Chan
2019-03-26